ISSA Case Analysis & Practical Application 3 — Questions and Answers
Question 1: A 17-year-old male wrestler is trying to cut 8 pounds in 2 weeks before competition. He plans to severely restrict water intake. What is your PRIMARY concern?
- He will lose muscle mass instead of fat
- Severe dehydration impairs performance and poses serious health risks (Correct answer)
- His metabolism will increase from the stress
- He will not meet the weight requirement due to muscle gain
Correct answer: Severe dehydration impairs performance and poses serious health risks
Rapid dehydration used for weight cutting significantly impairs physical performance and can cause dangerous health complications.
Question 2: A 40-year-old client with hyperlipidemia has total cholesterol of 240 mg/dL and high LDL. Which dietary change has the STRONGEST evidence for lowering LDL cholesterol?
- Replace saturated fats with unsaturated fats and increase soluble fiber (Correct answer)
- Eliminate all dietary cholesterol entirely
- Increase omega-6 fatty acid intake without limiting saturated fat
- Add coconut oil as the primary cooking fat
Correct answer: Replace saturated fats with unsaturated fats and increase soluble fiber
Replacing saturated fats with unsaturated fats and consuming soluble fiber (e.g., oats, legumes) are the most evidence-based strategies for lowering LDL.
Question 3: A client reports following a ketogenic diet but is experiencing headaches, fatigue, and irritability in the first week. What is the MOST likely cause?
- Excessive protein intake causing ammonia buildup
- Electrolyte and fluid loss as glycogen stores are depleted (Correct answer)
- Ketone bodies causing direct neurological toxicity
- Insufficient fat intake preventing ketosis
Correct answer: Electrolyte and fluid loss as glycogen stores are depleted
Glycogen depletion during keto adaptation releases stored water, causing electrolyte losses that produce the 'keto flu' symptoms.
Question 4: A 35-year-old male bodybuilder consumes 4,500 kcal/day during a bulking phase. His macros are 60% carbs, 25% protein, 15% fat. What concern should you address?
- Protein intake is too high and will stress the kidneys
- Fat intake is too low and may impair hormone production (Correct answer)
- Carbohydrate intake will cause immediate fat storage regardless of activity
- He needs to reduce total calories to prevent any fat gain
Correct answer: Fat intake is too low and may impair hormone production
Fat intake below 20% of total calories may compromise testosterone and other steroid hormone synthesis, which is critical for muscle building.
Question 5: A 62-year-old client recovering from hip replacement surgery asks about nutrition to support healing. What is the MOST important macronutrient to emphasize?
- Fat, to support anti-inflammatory prostaglandins
- Carbohydrates, to spare protein for energy
- Protein, to support tissue repair and prevent muscle wasting (Correct answer)
- Fiber, to prevent post-surgical constipation
Correct answer: Protein, to support tissue repair and prevent muscle wasting
Adequate protein (1.2–2.0 g/kg) is critical post-surgery to support wound healing, tissue repair, and prevention of sarcopenia.
Question 6: A client's 3-day food diary shows she averages 55 g of fiber per day. She complains of bloating and irregular bowel movements. What is your recommendation?
- Continue the high-fiber diet as these are temporary adaptation symptoms
- Gradually reduce fiber intake closer to the 25–38 g/day recommendation and increase water (Correct answer)
- Eliminate all plant foods until symptoms resolve
- Add a fiber supplement on top of current intake
Correct answer: Gradually reduce fiber intake closer to the 25–38 g/day recommendation and increase water
Consuming fiber significantly above the recommended 25–38 g/day can cause excessive fermentation, bloating, and altered bowel motility.
Question 7: A teenage female cross-country runner presents with stress fractures, loss of her menstrual period, and disordered eating patterns. This cluster of symptoms BEST describes:
- Iron deficiency anemia
- The Female Athlete Triad (Correct answer)
- Overtraining syndrome
- Exercise-induced hyponatremia
Correct answer: The Female Athlete Triad
The Female Athlete Triad is characterized by low energy availability (often with disordered eating), menstrual dysfunction, and low bone mineral density.
ISSA Case Analysis & Practical Application 3
A 17-year-old male wrestler is trying to cut 8 pounds in 2 weeks before competition.
He plans to severely restrict water intake.
What is your PRIMARY concern?